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Medical graduates’ early career choices of specialty and their eventual specialty destinations: UK prospective cohort studies

BMJ 2010; 341 doi: (Published 06 July 2010) Cite this as: BMJ 2010;341:c3199
  1. Michael J Goldacre, professor of public health1,
  2. L Laxton, research officer1,
  3. T W Lambert, statistician and study coordinator1
  1. 1UK Medical Careers Research Group, Unit of Health-Care Epidemiology, Department of Public Health, University of Oxford, Oxford OX3 7LF
  1. Correspondence to: M J Goldacre michael.goldacre{at}
  • Accepted 3 June 2010


Objective To report on doctors’ early choices of specialty at selected intervals after qualification, and eventual career destinations.

Design Questionnaire surveys.

Setting United Kingdom.

Participants Total of 15 759 doctors who qualified in 1974, 1977, 1983, 1993, and 1996, and their career destinations 10 years after graduation.

Results 15 759 doctors were surveyed one and three years after graduation and 12 108 five years after graduation. Career preferences at years 1, 3, and 5, and destinations at 10 years, were known for, respectively, 64% (n=10 154), 62% (n=9702), and 61% (n=7429) of the survey population. In the 1993 and 1996 cohorts, career destinations matched with year 1 choices for 54% (1890/3508) of doctors in year 1, 70% (2494/3579) in year 3, and 83% (2916/3524) in year 5. Corresponding results for the earlier cohorts (1974-83) were similar: 53% (3310/6264), 74% (4233/5752), and 82% (2976/3646). The match rates varied by specialty; for example, the rates were consistently high for surgery. Career destinations matched with year 1 choices for 74% (722/982) of doctors who specified a definite (rather than probable or uncertain) specialty choice in their first postgraduate year. About half of those who chose a hospital specialty but did not eventually work in it were working in general practice by year 10.

Conclusions Ten years after qualification about a quarter of doctors were working in a specialty that was different from the one chosen in their third year after graduation. This stayed reasonably constant across graduation cohorts despite the changes in training programmes over time. Subject to the availability of training posts, postgraduate training should permit those who have made early, definite choices to progress quickly into their chosen specialty, while recognising the need for flexibility for those who choose later.


  • We thank the doctors who replied to our questionnaires and Janet Justice, Alison Stockford, and Emma Ayres for clerical assistance with the surveys and with data preparation.

  • Contributors: MJG and TWL designed the study. LL analysed the data. MJG and LL wrote the first draft. All the authors contributed to further drafts, and all are guarantors. All authors had full access to all of the data in the study and take responsibility for the integrity of the data and accuracy of the data analysis.

  • Funding: The UK Medical Careers Research Group is funded by the Department of Health’s policy research programme. The Unit of Health-Care Epidemiology is funded by the National Institute for Health Research. The study sponsors had no role in the design, conduct, analysis, or reporting of the study. The views and opinions expressed in this paper do not necessarily reflect those of the sponsors.

  • Competing interests: All authors have completed the Unified Competing Interest form at (available on request from the corresponding author) and all authors want to declare: (1) financial support for the submitted work from the policy research programme, Department of Health. All authors also declare: (2) no financial relationships with commercial entities that might have an interest in the submitted work; (3) no spouses, partners, or children with relationships with commercial entities that might have an interest in the submitted work; (4) no non-financial interests that may be relevant to the submitted work.

  • Ethical approval: This study was approved by the Central Office for Research Ethics Committees, after referral to Brighton, Mid Sussex, and East Sussex local research ethics committees.

  • Data sharing: No additional data available.

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